Aims: To evaluate an web-based education program for nurses who administer moderate sedation for invasive procedures such as endoscopies. Background: Complications of moderate sedation administration include inadequate or over sedation, loss of airway, as well as drug induced apnea and hypotension. There is no universally accepted approach to educating clinicians in the safe and effect use of potent anesthetics used in moderate sedation. Therefore, a multimedia, web-based educational program for moderate sedation training based on American Society for Anesthesiologists and JCAHO guidelines was developed. Principles of Cognitive Flexibility Theory were used to design interactive education modules with nurses as the target audience. The modules developed for this Phase 1 project included a review safe practice guidelines, drug administration principles, as well as simulations for describing the complex pharmacokinetics and pharmacodynamics of commonly used analgesics and anesthetics. Methods: Thirty eight registered nurses were randomly assigned to one of two education groups. The only difference between the groups was the mode of training since both groups received the same didactic information. The control group received a booklet consisting of text and figures, while the experimental group received the web-based education program. Both groups were given pre-tests before and post-tests after completing the education session. Immediately following the post-test, an evaluation of nurse performance was conducted in a high fidelity patient simulator laboratory. In the simulator evaluation, nurses were asked to care for sedated patients undergoing procedures in four simulated scenarios. Dependent variables for the simulator evaluation included pre-test and post-test scores, as well as an observed performance score. The checklist for the performance score was developed by the investigators using a modified Delphi method. At the end of the simulations, nurses completed usability surveys and the NASA Task Load Index. Results: There was an improvement from pre-test scores to post-test scores for both groups. Participants' composite performance scores from the Delphi checklists for the simulations were 118.6 +/- 23.9 and 107.1 +/- 22.1 for the online and didactic education groups respectively (t(74)=2.71, p<.03). Post hoc analysis of time spent in the moderate sedation therapeutic window during the simulated endoscopic procedure was significantly longer for those trained in the computer-based group (17.0 +/- 2.4 minutes versus 15.4 +/- 2.4 minutes for the control group, t(37)=1.86, p<.05). No difference in mental workload during the simulations, as measured by the NASA Task Load Index, was found between groups. Implications: Interactive web-based training can play an important role in promoting patient safety during procedures requiring moderate sedation. The web-based moderate sedation education improved nurses' understanding of drug pharmacology and safe moderate sedation practices. It appears that the nurses who received the interactive training modules, which included pharmacology simulations, were better able to translate their training into improved clinical performance. Web-based training, if implemented appropriately, is an advantageous mode of training because of the ability to target large numbers of nurses in a cost effective manner.

<table><tr><td colspan="2" class="item-title">Improving Moderate Sedation Practice With Interactive Online Nursing Education</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Doig, Alexa K., RN, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Utah, College of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">10 S 2000 E, Salt Lake City, UT, 84112, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">801-581-4381</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">alexa.doig@nurs.utah.edu</td></tr><tr><td colspan="2" class="item-abstract">Aims: To evaluate an web-based education program for nurses who administer moderate sedation for invasive procedures such as endoscopies. Background: Complications of moderate sedation administration include inadequate or over sedation, loss of airway, as well as drug induced apnea and hypotension. There is no universally accepted approach to educating clinicians in the safe and effect use of potent anesthetics used in moderate sedation. Therefore, a multimedia, web-based educational program for moderate sedation training based on American Society for Anesthesiologists and JCAHO guidelines was developed. Principles of Cognitive Flexibility Theory were used to design interactive education modules with nurses as the target audience. The modules developed for this Phase 1 project included a review safe practice guidelines, drug administration principles, as well as simulations for describing the complex pharmacokinetics and pharmacodynamics of commonly used analgesics and anesthetics. Methods: Thirty eight registered nurses were randomly assigned to one of two education groups. The only difference between the groups was the mode of training since both groups received the same didactic information. The control group received a booklet consisting of text and figures, while the experimental group received the web-based education program. Both groups were given pre-tests before and post-tests after completing the education session. Immediately following the post-test, an evaluation of nurse performance was conducted in a high fidelity patient simulator laboratory. In the simulator evaluation, nurses were asked to care for sedated patients undergoing procedures in four simulated scenarios. Dependent variables for the simulator evaluation included pre-test and post-test scores, as well as an observed performance score. The checklist for the performance score was developed by the investigators using a modified Delphi method. At the end of the simulations, nurses completed usability surveys and the NASA Task Load Index. Results: There was an improvement from pre-test scores to post-test scores for both groups. Participants' composite performance scores from the Delphi checklists for the simulations were 118.6 +/- 23.9 and 107.1 +/- 22.1 for the online and didactic education groups respectively (t(74)=2.71, p&lt;.03). Post hoc analysis of time spent in the moderate sedation therapeutic window during the simulated endoscopic procedure was significantly longer for those trained in the computer-based group (17.0 +/- 2.4 minutes versus 15.4 +/- 2.4 minutes for the control group, t(37)=1.86, p&lt;.05). No difference in mental workload during the simulations, as measured by the NASA Task Load Index, was found between groups. Implications: Interactive web-based training can play an important role in promoting patient safety during procedures requiring moderate sedation. The web-based moderate sedation education improved nurses' understanding of drug pharmacology and safe moderate sedation practices. It appears that the nurses who received the interactive training modules, which included pharmacology simulations, were better able to translate their training into improved clinical performance. Web-based training, if implemented appropriately, is an advantageous mode of training because of the ability to target large numbers of nurses in a cost effective manner.</td></tr></table>

en_GB

dc.date.available

2011-10-26T20:08:08Z

-

dc.date.issued

2011-10-17

en_GB

dc.date.accessioned

2011-10-26T20:08:08Z

-

dc.description.sponsorship

Western Institute of Nursing

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